Physical Activity Readiness Questionnaire (PAR Q)

Please complete the form below.


PAR Q Form

 
Parent/Guardian Name *
Parent/Guardian Name
Childs Name *
Childs Name
Camp Date *
Does your child have or has he/she ever experienced/suffered with high or low blood pressure? *
Does your child have or has he/she ever experienced/suffered with elevated blood cholesterol? *
Does your child have or has he/she ever experienced/suffered with diabetes? *
Does your child have or has he/she ever experienced/suffered with chest pains brought on by physical exertion? *
Does your child have or has he/she ever experienced/suffered with epilepsy? *
Does your child have or has he/she ever experienced/suffered with dizziness or fainting? *
Does your child have or has he/she ever experienced/suffered with bone, joint or muscular problems including growing pains? *
Does your child have or has he/she ever experienced/suffered with asthma or other respiratory problems? *
Does your child have or has he/she ever experienced/suffered with any sustained injuries or illness? *
Does your child have or has he/she ever experienced/suffered with any allergies? *
Is your child currently taking any medication? *
Has your doctor ever advised your child not to exercise? *
Is there any reason not mentioned above why any type of physical activity may not be suitable for your child? *
In signing this form, I the parent/guardian of the aforementioned child, affirm that I have read this form in its entirety and I have answered the question accurately and to the best of my knowledge. I understand that my child is responsible for monitoring him or herself throughout any activity, and should any unusual symptoms occur, would cease participation and inform the instructor. In the event that medical clearance must be obtained prior to my child's participation in an exercise session, I agree to contact the GP and obtain written permission prior to the commencement of the exercise activity, and that this permission be given to the instructor. I understand that if my child fails to behave in manner that is polite and social, he or she could be suspended from the camps. *